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Impact of heart rate on central aortic pressures and hemodynamics: analysis from the CAFE (Conduit Artery Function
Bryan Williams1, Peter S Lacy,
1Department of Cardiovascular Sciences, University of Leicester School of Medicine, and the Leicester NIHR Cardiovascular Biomedical Research Unit, Leicester, UK. bw17@le.ac.uk
Insights
Beta-blockers lower central aortic pressure less effectively than other therapies due to heart rate reduction. This effect is a major mechanism explaining the difference in blood pressure management strategies.
Area of Science:
- Cardiovascular pharmacology
- Hypertension management
- Hemodynamics
Background:
- Beta-blockers show reduced efficacy in cardiovascular event reduction compared to other antihypertensive therapies.
- The mechanism behind this shortfall, particularly the role of heart rate (HR) reduction, is debated.
Purpose of the Study:
- To investigate the role of heart rate (HR) as a determinant of central aortic pressure lowering in hypertensive patients.
- To understand why atenolol-based therapy was less effective than amlodipine-based therapy in the CAFE study.
Main Methods:
- Central aortic pressures were calculated from brachial pressure and radial pulse wave analysis.
- Analysis included 7,146 measurements from 2,073 hypertensive patients over 4 years.
Main Results:
- Heart rate (HR) was inversely related to central aortic systolic and pulse pressures (p < 0.001).
- Lower HRs were associated with increased wave reflection (higher augmentation index).
- Adjusted for brachial blood pressure, HR was the primary determinant of central pressures, accounting for 92% of variability with brachial BP.
Conclusions:
- Heart rate reduction is a key mechanism explaining the less effective central aortic pressure reduction per unit of brachial pressure change with beta-blocker therapies.
- Differences in central aortic pressures between drug classes were significantly reduced after adjusting for HR.
Objectives:
The CAFE (Conduit Artery Function Evaluation) study showed less effective central aortic pressure lowering with atenolol-based therapy versus amlodipine-based therapy in people with hypertension. The present study examined the importance of heart rate (HR) as a determinant of this effect.
Background:
Recent analyses have suggested that beta-blockers are less effective at reducing cardiovascular events than alternative blood pressure (BP)-lowering therapies. There has been much debate about the mechanism for this shortfall in benefit and specifically the role of HR lowering by beta-blockers.
Methods:
Central pressures were derived from brachial pressure and radial pulse wave analysis in 2,073 patients, and 7,146 measurements were recorded and analyzed over follow-up for up to 4 years.
Results:
There was no impact of HR on brachial systolic or pulse pressures; however, there was a highly significant inverse relationship between HR and central aortic systolic and pulse pressures (p < 0.001). This was dependent on a strong inverse relationship between HR and augmentation index, indicative of increased wave reflection at lower HRs. Multiple regression, adjusted for brachial BP, showed HR to be the major determinant of central pressures. Moreover, HR and brachial BP accounted for 92% of the variability in central systolic and pulse pressures. Consequently, drug-related differences in central aortic pressures were markedly attenuated after adjustment for HR.
Conclusions:
When comparing beta-blocker-based treatments with other BP-lowering strategies, HR reduction with beta-blockers is a major mechanism accounting for less effective central aortic pressure reduction per unit change in brachial pressure.
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